International Major Medical Insurance | Benefits

The Global Medical Insurance plan provides you with four plan levels to choose from: Bronze, Silver, Gold, and Platinum. Each level of the plan offers different coverage benefits and amounts to suit different health insurance needs.

We also encourage you to contact our customer support team who will be able to assist you with finding the correct plan to fit your needs and explain the different levels in more detail.

Bronze

  • Lifetime Maximum Limit $1 million per individual
  • Deductible Per Period of Coverage $250 to $10,000
  • Provider Network UnitedHealthcare Network
  • Treatment outside the U.S. 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. Using Medical Concierge 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. PPO Network Subject to deductible No coinsurance
  • Treatment inside the U.S. Non-PPO Network Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.
  • Coinsurance International — 100%
    U.S. In-Network — 100%
    U.S. Out of Network — 80% up to $5,000 then 100%
  • Outpatient

    $300 maximum per visit — lab tests; $250 maximum per visit – diagnostic X-rays

    $500 maximum limit — specialists/ physician charges (pre-inpatient / post-inpatient)

    Subject to deductible and coinsurance
  • Teleconsultation N/A
  • Mental/Nervous N/A
  • Hospital Emergency Room Injury Subject to deductible and coinsurance
  • Hospital Emergency Room Illness Subject to deductible and coinsurance. Covered only if admitted as inpatient.
  • Hospitalization / Room & Board Subject to deductible and coinsurance for average semi-private room rate.
  • Intensive Care Unit Subject to deductible and coinsurance
  • CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy Subject to deductible and coinsurance. $600 maximum limit per examination
  • Surgery Subject to deductible and coinsurance.
  • Assistant Surgeon 20% of primary surgeon’s charge
  • Chemotherapy or Radiation Therapy Subject to deductible and coinsurance.
  • Ancillary Services Covered under Hospitalization room & board/professional fees
  • Maternity Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program No Coverage
  • Podiatry Care NA
  • Physical Therapy

    Available for 90 days following inpatient treatment or outpatient surgery

    Maximum limit per visit: $40
    Maximum visits: 10
  • Transplants $250,000 lifetime max.
  • Prescription Drugs, Dressing, and Durable Medical Equipment Subject to deductible and coinsurance. Available for 90 days following related inpatient treatment or outpatient surgery. $600 maximum limit per event (includes dressing and durable medical equipment)
  • Expatriate Prescription Services Program N/A
  • Orphan or Biologic Drugs Available when all conditions are met:
    • Approved in writing by company
    • Medically necessary
    • Not experimental or investigational
    Applies to period of coverage max.
    Max limit applies towards lifetime max.

    Inpatient Treatment maximum limit: $250,000.

    Outpatient Surgery: up to the maximum limit.

    Subject to deductible and coinsurance.

    Does not apply to maximum limit per event
  • Healthy Travel Preventative Coverage $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination.
  • Vision Optional Rider
  • Emergency Local Ambulance (Injury or illness resulting in hospitalization) $1,500 maximum limit per event Not subject to deductible or coinsurance
  • Emergency Evacuation $50,000 maximum per period of coverage. Not subject to deductible or coinsurance
  • Emergency Reunion Lifetime Maximum: $10,000
    Maximum days: 15
    Meal Maximum Limit per day: $25 Not subject to deductible or coinsurance
  • Interfacility Ambulance Transfer (Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.) $1,500 maximum limit per event. Not subject to deductible or coinsurance
  • Political Evacuation and Repatriation N/A
  • Remote Transportation N/A
  • Return of Mortal Remains

    Maximum Limit: $25,000

    Local Burial / Cremation Maximum Limit: $5,000 Not subject to deductible or coinsurance
  • Complementary Medicine N/A
  • Dental Treatment No Coverage
  • Traumatic Dental Injury No Coverage
  • Non-Emergency Dental Optional Rider
  • Hospital Indemnity (Outside the U.S. only)

    Private Hospital: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage.

    Public Hospital: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage.

    Not subject to deductible or coinsurance
  • Supplemental Accident N/A
  • Adult Preventative Care (Age 19 or older) N/A
  • Child Preventative Care (Through age 18) N/A
  • Pre-Existing Conditions
  • Known Disclosed Conditions No Coverage
  • Non-disclosed Conditions No Coverage
  • Unknown Conditions After 24 months of continuous coverage No Coverage
  • Lifeworks Consultation N/A
  • Optional Coverage
  • Individual Term Life Insurance (Amounts shown are the Principal Sums per unit) Age 31 days – 18 years: $5,000
    Age 19–29 years: $75,000
    Age 30–39 years: $50,000
    Age 40–44 years: $35,000
    Age 45–49 years: $25,000
    Age 50–54 years: $20,000
    Age 55–59 years: $15,000
    Age 60–64 years: $10,000
    Age 65–69 years: $7,500
  • Accidental Death & Dismemberment (AD&D) Included with Individual Term Life Insurance

    Accidental Loss of Life: Principal Sum*

    Accidental Total Loss of 2 body parts**: Principal Sum*

    Accidental Total Loss of 1 body part**: 50% of Principal Sum* (Benefit based on age at time of death** ”body part” means hand, foot, or eye)
  • Terrorism (Platinum plan option) $50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details)
  • Sports (Gold and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded)

    $10,000 lifetime maximum for amateur athletics

    Adventure Sports:
    • Through age 49 years: $50,000 lifetime maximum
    • Age 50 years – age 59 years: $30,000 lifetime maximum
    • Age 60 years – age 64 years: $15,000 lifetime maximum
  • Dental Rider $750 per period of coverage
    $50 deductible (max. 2 per family)
    Routine services: 90% (deductible is waived)
    Minor restorative: 70%
    Major restorative: 50%
    6-month waiting period
  • Vision Rider Exams: up to $100 per 24 months
    Materials: up to $150 per 24 months
  • Remote Mental Health Service N/A
  • Bereavement Counseling N/A
  • Universal Rx Drug Card N/A
  • The Family Matters Program N/A

Silver

  • Lifetime Maximum Limit $5 million per individual
  • Deductible Per Period of Coverage $250 to $10,000
  • Provider Network UnitedHealthcare Network
  • Treatment outside the U.S. 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. Using Medical Concierge 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. PPO Network Subject to deductible No coinsurance
  • Treatment inside the U.S. Non-PPO Network Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.
  • Coinsurance International — 100%
    U.S. In-Network — 100%
    U.S. Out of Network — 80% up to $5,000 then 100%
  • Outpatient

    $300 maximum per visit — lab tests; $250 maximum per visit — diagnostic X-rays

    25 combined maximum visits

    $70 per visit/examination — specialists/physician charges

    $50 per visit/examination — chiropractor charges (medical order or treatment plan required)

    $500 per consultation — surgery intervention consultation charges

    Subject to deductible and coinsurance
  • Teleconsultation N/A
  • Mental/Nervous Subject to deductible and coinsurance. Outpatient after 12 months of continuous coverage
  • Hospital Emergency Room Injury Subject to deductible and coinsurance
  • Hospital Emergency Room Illness Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient.
  • Hospitalization / Room & Board Subject to deductible and coinsurance for average semi-private room rate. All subject to $600 per day; 240 day maximum
  • Intensive Care Unit Subject to deductible and coinsurance. $1,500 limit per day — 180 days of coverage per event
  • CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy Subject to deductible and coinsurance. $600 maximum limit per examination
  • Surgery Subject to deductible and coinsurance.
  • Assistant Surgeon 20% of primary surgeon’s charge
  • Chemotherapy or Radiation Therapy Subject to deductible and coinsurance.
  • Ancillary Services $400 per day
  • Maternity Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program No Coverage
  • Podiatry Care NA
  • Physical Therapy Maximum limit per visit: $40
    Maximum visits per day: 1
    Maximum visits: 30
  • Transplants $250,000 lifetime max.
  • Prescription Drugs, Dressing, and Durable Medical Equipment

    Subject to deductible and coinsurance.

    90 day supply per prescription following related covered event.

    U.S Retail Pharmacy out-of-network: 80%

    International Retail Pharmacy: 100%
  • Expatriate Prescription Services Program

    Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com

    Dispensing maximum: 180 days
  • Orphan or Biologic Drugs Available when all conditions are met:
    • Approved in writing by company
    • Medically necessary
    • Not experimental or investigational
    Applies to period of coverage max.
    Max limit applies towards lifetime max.

    Outpatient and Emergency Department Treatment maximum limit: $250,000.

    Subject to deductible and coinsurance.
  • Healthy Travel Preventative Coverage $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination.
  • Vision Optional Rider
  • Emergency Local Ambulance (Injury or illness resulting in hospitalization) $1,500 maximum limit per event Not subject to deductible or coinsurance
  • Emergency Evacuation $50,000 maximum per period of coverage. Not subject to deductible or coinsurance
  • Emergency Reunion No Coverage
  • Interfacility Ambulance Transfer (Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.) $1,500 maximum limit per event. Not subject to deductible or coinsurance
  • Political Evacuation and Repatriation N/A
  • Remote Transportation N/A
  • Return of Mortal Remains

    Maximum Limit: $25,000

    Local Burial / Cremation Maximum Limit: $5,000 Not subject to deductible or coinsurance
  • Complementary Medicine N/A
  • Dental Treatment No Coverage
  • Traumatic Dental Injury No Coverage
  • Non-Emergency Dental Optional Rider
  • Hospital Indemnity (Outside the U.S. only)

    Private Hospital: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage.

    Public Hospital: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage.

    Not subject to deductible or coinsurance
  • Supplemental Accident N/A
  • Adult Preventative Care (Age 19 or older) N/A
  • Child Preventative Care (Through age 18) $70 maximum per visit, 3 visit limit per period of coverage. Not subject to deductible or coinsurance
  • Pre-Existing Conditions
  • Known Disclosed Conditions Covered the same as any conditions unless excluded by rider
  • Non-disclosed Conditions No Coverage
  • Unknown Conditions After 24 months of continuous coverage Period of coverage: $5,000
    Lifetime Maximum: $50,000
  • Lifeworks Consultation N/A
  • Optional Coverage
  • Individual Term Life Insurance (Amounts shown are the Principal Sums per unit) Age 31 days – 18 years: $5,000
    Age 19–29 years: $75,000
    Age 30–39 years: $50,000
    Age 40–44 years: $35,000
    Age 45–49 years: $25,000
    Age 50–54 years: $20,000
    Age 55–59 years: $15,000
    Age 60–64 years: $10,000
    Age 65–69 years: $7,500
  • Accidental Death & Dismemberment (AD&D) Included with Individual Term Life Insurance

    Accidental Loss of Life: Principal Sum*

    Accidental Total Loss of 2 body parts**: Principal Sum*

    Accidental Total Loss of 1 body part**: 50% of Principal Sum* (Benefit based on age at time of death** ”body part” means hand, foot, or eye)
  • Terrorism (Platinum plan option) $50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details)
  • Sports (Gold and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded)

    $10,000 lifetime maximum for amateur athletics

    Adventure Sports:
    • Through age 49 years: $50,000 lifetime maximum
    • Age 50 years – age 59 years: $30,000 lifetime maximum
    • Age 60 years – age 64 years: $15,000 lifetime maximum
  • Dental Rider $750 per period of coverage
    $50 deductible (max. 2 per family)
    Routine services: 90% (deductible is waived)
    Minor restorative: 70%
    Major restorative: 50%
    6-month waiting period
  • Vision Rider Exams: up to $100 per 24 months
    Materials: up to $150 per 24 months
  • Remote Mental Health Service N/A
  • Bereavement Counseling Lifetime Max: $300
  • Universal Rx Drug Card N/A
  • The Family Matters Program N/A

Gold

  • Lifetime Maximum Limit $5 million per individual
  • Deductible Per Period of Coverage $250 to $25,000
  • Provider Network UnitedHealthcare Network
  • Treatment outside the U.S. 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. Using Medical Concierge 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. PPO Network Subject to deductible No coinsurance
  • Treatment inside the U.S. Non-PPO Network Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.
  • Coinsurance International — 100%
    U.S. In-Network — 100%
    U.S. Out of Network — 80% up to $5,000 then 100%
  • Outpatient Subject to deductible and coinsurance
  • Teleconsultation Covered
  • Mental/Nervous Subject to deductible and coinsurance. $10,000 maximum. Available after 12 months of continuous coverage
  • Hospital Emergency Room Injury Subject to deductible and coinsurance
  • Hospital Emergency Room Illness Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient.
  • Hospitalization / Room & Board Subject to deductible and coinsurance for average semi-private room rate.
  • Intensive Care Unit Subject to deductible and coinsurance
  • CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy Subject to deductible and coinsurance
  • Surgery Subject to deductible and coinsurance.
  • Assistant Surgeon 20% of primary surgeon’s charge
  • Chemotherapy or Radiation Therapy Subject to deductible and coinsurance.
  • Ancillary Services Covered under Hospitalization room & board/professional fees
  • Maternity Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program No Coverage
  • Podiatry Care $750 max limit
  • Physical Therapy Maximum limit per visit: $50
    Maximum visits per day: 1
    Medical order required
  • Transplants $1 million lifetime max.
  • Prescription Drugs, Dressing, and Durable Medical Equipment

    Subject to deductible and coinsurance.

    90 day supply per prescription following related covered event.

    U.S Retail Pharmacy out-of-network: 80%

    International Retail Pharmacy: 100%
  • Expatriate Prescription Services Program

    Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com

    Dispensing maximum: 180 days
  • Orphan or Biologic Drugs Available when all conditions are met:
    • Approved in writing by company
    • Medically necessary
    • Not experimental or investigational
    Applies to period of coverage max.
    Max limit applies towards lifetime max.

    Inpatient & Outpatient Treatment maximum limit: $250,000.

    Subject to deductible and coinsurance.
  • Healthy Travel Preventative Coverage $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination.
  • Vision Optional Rider
  • Emergency Local Ambulance (Injury or illness resulting in hospitalization) Subject to deductible or coinsurance
  • Emergency Evacuation Up to lifetime maximum limit. Not subject to deductible or coinsurance
  • Emergency Reunion Lifetime Maximum: $10,000
    Maximum days: 15
    Meal Maximum Limit per day: $25 Not subject to deductible or coinsurance
  • Interfacility Ambulance Transfer (Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.) Subject to deductible and coinsurance
  • Political Evacuation and Repatriation N/A
  • Remote Transportation N/A
  • Return of Mortal Remains

    Maximum Limit: $25,000

    Local Burial / Cremation Maximum Limit: $5,000 Not subject to deductible or coinsurance
  • Complementary Medicine $500 maximum limit per period of coverage
  • Dental Treatment Max. Limit: $100 (treatment due to unexpected pain to sound natural teeth) Max. Limit: $500 (non-emergency treatment at a dental provider’s office due to an accident)
  • Traumatic Dental Injury Covered
  • Non-Emergency Dental Optional Rider
  • Hospital Indemnity (Outside the U.S. only)

    Private Hospital: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage.

    Public Hospital: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage.

    Not subject to deductible or coinsurance
  • Supplemental Accident $300 of eligible medical expenses following an accident. Not subject to deductible or coinsurance
  • Adult Preventative Care (Age 19 or older) $250 per period of coverage. Not subject to deductible or coinsurance
  • Child Preventative Care (Through age 18) $200 per period of coverage. Not subject to deductible or coinsurance
  • Pre-Existing Conditions
  • Known Disclosed Conditions Covered the same as any conditions unless excluded by rider
  • Non-disclosed Conditions No Coverage
  • Unknown Conditions After 24 months of continuous coverage Period of coverage: $5,000
    Lifetime Maximum: $50,000
  • Lifeworks Consultation N/A
  • Optional Coverage
  • Individual Term Life Insurance (Amounts shown are the Principal Sums per unit) Age 31 days – 18 years: $5,000
    Age 19–29 years: $75,000
    Age 30–39 years: $50,000
    Age 40–44 years: $35,000
    Age 45–49 years: $25,000
    Age 50–54 years: $20,000
    Age 55–59 years: $15,000
    Age 60–64 years: $10,000
    Age 65–69 years: $7,500
  • Accidental Death & Dismemberment (AD&D) Included with Individual Term Life Insurance

    Accidental Loss of Life: Principal Sum*

    Accidental Total Loss of 2 body parts**: Principal Sum*

    Accidental Total Loss of 1 body part**: 50% of Principal Sum* (Benefit based on age at time of death** ”body part” means hand, foot, or eye)
  • Terrorism (Platinum plan option) $50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details)
  • Sports (Gold and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded)

    $10,000 lifetime maximum for amateur athletics

    Adventure Sports:
    • Through age 49 years: $50,000 lifetime maximum
    • Age 50 years – age 59 years: $30,000 lifetime maximum
    • Age 60 years – age 64 years: $15,000 lifetime maximum
  • Dental Rider $750 per period of coverage
    $50 deductible (max. 2 per family)
    Routine services: 90% (deductible is waived)
    Minor restorative: 70%
    Major restorative: 50%
    6-month waiting period
  • Vision Rider Exams: up to $100 per 24 months
    Materials: up to $150 per 24 months
  • Remote Mental Health Service N/A
  • Bereavement Counseling Lifetime Max: $300
  • Universal Rx Drug Card N/A
  • The Family Matters Program N/A

Platinum

  • Lifetime Maximum Limit $8 million per individual
  • Deductible Per Period of Coverage $100 to $25,000
  • Provider Network UnitedHealthcare Network
  • Treatment outside the U.S. 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. Using Medical Concierge 50% of deductible waived, up to a maximum of $2,500. No coinsurance
  • Treatment inside the U.S. PPO Network Subject to deductible No coinsurance
  • Treatment inside the U.S. Non-PPO Network Subject to deductible — Plan pays 80% of the next $5,000 of eligible expenses, then 100% to the overall maximum per period of coverage.
  • Coinsurance International — 100%
    U.S. In-Network — 100%
    U.S. Out of Network — 80% up to $5,000 then 100%
  • Outpatient Subject to deductible and coinsurance
  • Teleconsultation Covered
  • Mental/Nervous Subject to deductible and coinsurance. $50,000 lifetime maximum. Available after 12 months of continuous coverage.
  • Hospital Emergency Room Injury Subject to deductible and coinsurance
  • Hospital Emergency Room Illness Subject to deductible and coinsurance. Additional $250 deductible if not admitted as an inpatient.
  • Hospitalization / Room & Board Subject to deductible and coinsurance for average semi-private room rate.
  • Intensive Care Unit Subject to deductible and coinsurance
  • CAT Scans, MRI, Echocardiography, Endoscopy, Gastroscopy, Cystoscopy Subject to deductible and coinsurance
  • Surgery Subject to deductible and coinsurance.
  • Assistant Surgeon 20% of primary surgeon’s charge
  • Chemotherapy or Radiation Therapy Subject to deductible and coinsurance.
  • Ancillary Services Covered under Hospitalization room & board/professional fees
  • Maternity Delivery, preventative care, newborn care & congenital disorders, Family Matters Maternity Program

    Available after 10 months of continuous coverage.

    Maternity deductible: $2,000 (in addition to plan deductible)

    Lifetime Maximum: $50,000
  • Podiatry Care $750 max limit
  • Physical Therapy Maximum limit per visit: $50
    Maximum visits per day: 1
    Medical order required
  • Transplants $2 million lifetime max.
  • Prescription Drugs, Dressing, and Durable Medical Equipment

    U.S Retail Pharmacy: prescription drug card required.

    Copay per 30-day supply: $20 for generic/ $40 for brand name where generic is not available.

    International Retail Pharmacy (subject to deductible): $100%
  • Expatriate Prescription Services Program

    Copay per 30-day supply: $20 for generic/$40 for non-preferred brand name. Must enroll via provider website: www.expatps.com

    Dispensing maximum: 180 days
  • Orphan or Biologic Drugs Available when all conditions are met:
    • Approved in writing by company
    • Medically necessary
    • Not experimental or investigational
    Applies to period of coverage max.
    Max limit applies towards lifetime max.

    Maximum limit: $250,000.

    U.S. Retail Pharmacy & expatriate prescription services program: Subject to copayments.

    International retail pharmacy: Subject to deductible and coinsurance.

    Inpatient & Outpatient medical Treatment: Subject to deductible and coinsurance.
  • Healthy Travel Preventative Coverage $250 lifetime maximum. Not subject to deductible or coinsurance. Applies to vaccinations and preventative prescription drugs administered by a physician within 30 days prior to the Insured person's initial effective date and before departing to any destination.
  • Vision

    Exams: up to $100 per 24 months

    Materials: up to $150 per 24 months
  • Emergency Local Ambulance (Injury or illness resulting in hospitalization) Not subject to deductible or coinsurance
  • Emergency Evacuation Up to lifetime maximum limit. Not subject to deductible or coinsurance
  • Emergency Reunion Lifetime Maximum: $10,000
    Maximum days: 15
    Meal Maximum Limit per day: $25 Not subject to deductible or coinsurance
  • Interfacility Ambulance Transfer (Transfer from one licensed health care facility to another licensed health care facility- Applies only in the U.S.) Not subject to deductible and coinsurance
  • Political Evacuation and Repatriation $10,000 lifetime maximum
  • Remote Transportation $5,000 per period of coverage up to $20,000 lifetime maximum. Not subject to deductible or coinsurance
  • Return of Mortal Remains $50,000 lifetime maximum. Not subject to deductible or coinsurance
  • Complementary Medicine $500 maximum limit per period of coverage
  • Dental Treatment $750 per period of coverage; $50 deductible (max. 2 per family)
    Routine services: 90% (deductible waived)
    Minor restorative: 70%
    Major restorative: $50%
    6 month waiting period
  • Traumatic Dental Injury Covered
  • Non-Emergency Dental $750 maximum per period of coverage; $50 individual deductible, applies to minor restorative and major restorative services.
  • Hospital Indemnity (Outside the U.S. only)

    Private Hospital: $400 maximum limit per overnight and $4,000 maximum limit per period of coverage.

    Public Hospital: $500 maximum limit per overnight and $5,000 maximum limit per period of coverage.

    Not subject to deductible or coinsurance
  • Supplemental Accident $500 maximum limit per accident. Not subject to deductible or coinsurance
  • Adult Preventative Care (Age 19 or older) $500 per period of coverage. Not subject to deductible or coinsurance
  • Child Preventative Care (Through age 18) $400 per period of coverage. Not subject to deductible or coinsurance
  • Pre-Existing Conditions
  • Known Disclosed Conditions Covered if disclosed and not excluded by rider
  • Non-disclosed Conditions Covered if disclosed and not excluded by rider
  • Unknown Conditions After 24 months of continuous coverage Covered if disclosed and not excluded by rider
  • Lifeworks Consultation LifeWorks will provide 24/7 counseling services through a master’s level counselor. Through virtual counseling services, individuals are able to get immediate counseling in crisis situations. Additional services available through the EAP program include an in-person counseling option while within the United States, LifeWorks services, legal and financial advice, management consultations, and access to many other support resources.
  • Optional Coverage
  • Individual Term Life Insurance (Amounts shown are the Principal Sums per unit) Age 31 days – 18 years: $5,000
    Age 19–29 years: $75,000
    Age 30–39 years: $50,000
    Age 40–44 years: $35,000
    Age 45–49 years: $25,000
    Age 50–54 years: $20,000
    Age 55–59 years: $15,000
    Age 60–64 years: $10,000
    Age 65–69 years: $7,500
  • Accidental Death & Dismemberment (AD&D) Included with Individual Term Life Insurance

    Accidental Loss of Life: Principal Sum*

    Accidental Total Loss of 2 body parts**: Principal Sum*

    Accidental Total Loss of 1 body part**: 50% of Principal Sum* (Benefit based on age at time of death** ”body part” means hand, foot, or eye)
  • Terrorism (Platinum plan option) $50,000 lifetime maximum for Eligible Medical Expenses arising out of injury or illness incurred by the Insured as a result of or in connection with an act of terrorism (Refer to rider for more details)
  • Sports (Gold and Platinum plan options) (Refer to rider for a comprehensive list of sports excluded)

    $10,000 lifetime maximum for amateur athletics

    Adventure Sports:
    • Through age 49 years: $50,000 lifetime maximum
    • Age 50 years – age 59 years: $30,000 lifetime maximum
    • Age 60 years – age 64 years: $15,000 lifetime maximum
  • Dental Rider Dental treatment benefit already included; no rider required
  • Vision Rider Vision Care benefit already included; no rider required
  • Remote Mental Health Service Covered
  • Bereavement Counseling Lifetime Max: $300
  • Universal Rx Drug Card Generic: $20
    Brand: (when generic is unavailable): $40
    Copayments are per 30-day supply
    Dispensing maximum per prescription: 90 days
  • The Family Matters Program Provides educational information on pregnancy and provides suggestions for a healthy lifestyle

Pre-existing Conditions

Pre-existing conditions coverage is excluded from the Bronze level of the plan. On the Silver, Gold, and Platinum plan options, conditions that are fully disclosed on the application and have not been excluded or restricted by a rider will be covered the same as any illness. Conditions, including any complications therefrom, that are known and not fully disclosed on the application will not be covered.

On the Silver, Gold, and Platinum plan options, unknown pre-existing conditions that existed at or prior to the effective date can be covered after 24 months of continuous coverage. These levels will provide a $50,000 lifetime benefit for eligible pre-existing conditions, subject to a maximum of $5,000 per period of coverage.

On the Silver and Gold levels, if applicants can verify their prior comprehensive health insurance, with no significant break in coverage (63 days), IMG may accept this as Creditable Coverage and provide a pre-existing conditions waiver (final decision is subject to Underwriter approval). Creditable Coverage is defined as a group health plan provided by a U.S. employer or Health Insurance Issuer, individual major medical health insurance provided by a Health Insurance Issuer, or other Public Health Plan. (any comprehensive health plan established or maintained by a State or the U.S. government).

The following illnesses which existed, manifest themselves, or are treated, or have treatment recommended prior to or during the first 180 days of coverage from the initial effective date are considered pre-existing conditions and are subject to the waiting period and other limitation of coverage described above: acne, asthma, allergies, tonsillectomy, back conditions, adenoidectomy, hemorrhoids or hemorrhoidectomy, disorders or the reproductive system, hysterectomy, hernia, gall bladder or gall stones and kidney stones, any condition of the breast, and any condition of the prostate.

The above is a summary schedule of benefits. Benefits are subject to the deductible and coinsurance unless otherwise noted. NA (Not Applicable); URC (Usual, Reasonable and Customary); SAAI (Same As Any Illness). For a further description of benefits, please refer to the Master Certificates of the plan.

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